Lyme disease - early disseminated

• Alternative Names

  Lyme disease - secondary or stage 2; Stage 2 Lyme disease, Bannwarth syndrome

• Causes, incidence, and risk factors

  Lyme disease is transmitted through the bite of an infected tick. Secondary Lyme disease develops within days to months after the tick bite. The infection spreads through the lymph system or bloodstream.

• Symptoms

  Some patients will remember having a tick bite or symptoms of stage 1 Lyme disease. Some patients with early disseminated or secondary Lyme disease may not have any history of symptoms, tick bites, or skin rashes.

  Lyme disease can affect the central nervous system and heart (cardiac system). Symptoms can come and go and may disappear after days, weeks, or months.

  Symptoms include:

  • Blurred vision
  • Fainting
  • Fatigue
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Headache
  • Heart palpitations
  • Light-headedness
  • Joint inflammation in the knees and other large joints
  • Lethargy
  • Muscle pains
  • Stiff neck

  Other symptoms that can occur with this disease:

  • Abnormal sensitivity to light
  • Confusion
  • Decreased consciousness
  • Drooping eyelids
  • Dysfunctional movement
  • Facial paralysis (also called Bell's palsy)
  • Hallucinations
  • Loss of muscle function and feeling
  • Nausea and vomiting
  • Numbness and tingling
  • Speech impairment
• Signs and tests

  A physical examination may show signs of nervous system (neurological) or heart problems.

  Tests that may be done include:

  • Chest x-ray
  • ECG
  • ELISA test to screen for substances specific to the infection (in blood)
  • Examination of cerebrospinal fluid
  • Western blot to confirm the presence of antibodies to Borrelia burgdorferi
• Treatment

  The objective of treatment is to get rid of the infection with antibiotics. The medicines are given for up to 28 days. A second round of antibiotics may be needed. The most commonly used antibiotics are doxycycline, amoxicillin, cefuroxime, and ceftriaxone.

  Antibiotics given through a vein (intravenous) are needed for patients who develop serious nervous system-related complications or arthritis that does not get better with medicines taken by mouth.

• Expectations (prognosis)

  Symptoms of arthritis may not respond to treatment. Other symptoms should improve with treatment.

  Rarely, a person will continue to have symptoms that can sometimes interfere with daily activities. Some people call this post-Lyme disease syndrome. There is no effective treatment for this syndrome.

• Complications

  Complications include chronic persistent Lyme disease.

• Calling your health care provider

  Call your health care provider if you develop symptoms of this disorder.

• Prevention

  Getting diagnosed early and treating Lyme disease with antibiotics are the most effective ways to prevent secondary Lyme disease.

  When walking or hiking in wooded or grassy areas:

  • Spray all exposed skin and your clothing with insect repellant (spray outdoors only, do not use on face, use just enough to cover all other exposed skin, don't spray under clothing, don't apply over wounds or irritated skin, wash skin after going inside)
  • Wear light-colored clothing to make it easier to spot ticks
  • Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks
  • Wear high boots, preferably rubber

  Check yourself and your pets frequently during and after your walk or hike. Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp.

• References

  Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089-1134.

  Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clinic Proc. 2008;83:566-571.

  Clark RP, Hu LT. Prevention of Lyme disease and other tick-borne infections. Infect Dis Clin North Am. 2008;22:381-396.

Review Date: 3/17/2009

Reviewed By: Jatin M. Vyas, PHD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.